【摘要】 背景与目的:同步放化疗已成为有高危因素的宫颈癌术后患者的标准治疗,与单纯放疗相比,同步放化疗确实提高了疗效,但同时也增加了血液学不良反应。本研究通过比较对骨髓进行限量的调强放疗(bone marrow-sparing intensity-modulated radiotherapy,BMS-IMRT)与未对骨髓进行限量的调强放疗(conventional intensity-modulated radiotherapy,IMRT)、三维适形放疗(three-dimension conformalradiation therapy,3D-CRT)在宫颈癌根治术后患者靶体积覆盖及危及器官(organ at risk,OAR)保护方面的差异,确定BMS-IMRT的剂量学优势。方法:对10例宫颈癌根治术后患者分别设计出3D-CRT(四野盒式)、IMRT和BMS-IMRT的3种治疗计划并比较靶区及危及器官剂量分布。靶区处方剂量均为45 Gy,危及器官包括骨髓、小肠、膀胱、直肠和股骨头。所有计划在Pinnacle3(Version 9.2 f)治疗计划系统上完成,最终的剂量计算采用串筒卷积迭加算法进行。结果:3组的靶区覆盖率相似(P>0.05)。BMS-IMRT组的骨髓V5、V10、V20、V30及V40均低于3D-CRT组(P<0.05),且V20、V30、V40低于IMRT组(P<0.05),而BMS-IMRT组与IMRT组小肠、膀胱、直肠的受量差异无统计学意义(P>0.05)。结论:对于宫颈癌术后患者,BMS-IMRT计划在降低骨髓剂量方面优于IMRT和3D-CRT。宫颈癌术后放疗计划设计中增加骨髓的限量有助于降低急性骨髓抑制的发生率。更多还原

【Abstract】 Background and purpose: Concurrent chemoradiotherapy is the standard treatment modality for patients with high-risk cervical cancer after hysterectomy.The delivery of cisplatin-based chemotherapy with radiotherapy improved survival compared with radiotherapy alone,but may be associated with high rates of acute hematologic toxicity.The purpose of this study was to investigate the dosimetric benefits of bone marrow-sparing intensity-modulated radiotherapy(BMS-IMRT) compared with conventional intensity-modulated radiotherapy(IMRT) and three-dimension conformal radiation therapy(3D-CRT) techniques in the treatment of patients with cervical cancer after hysterectomy.Methods: The four-field box 3D-CRT,IMRT and BMS-IMRT were generated on 10 cervical cancer patients after hysterectomy,which actually treated with BMS-IMRT techniques.The prescribed dose to the PTV was 45 Gy.All plans had 95% of PTV volume received the prescription.The organs at risk included bone marrow,small bowel,rectum,bladder and femoral head.All plans were created in the Pinnacle3(Version 9.2 f) and the final doses were calculated using the collapse cone superposition and convolution algorithm.The dosimetric comparisons of target and organs at risk were performed among the three techniques.Results: The PTV coverage in 3D-CRT,IMRT and BMS-IMRT plans was similar(P>0.05).The BMS-IMRT reduced the bone marrow V5(volume receiving 5 Gy),V10,V20,V30,V40 and V20,V30,V40,compared to the 3D-CRT and IMRT,respectively(P<0.05).For the small bowel,bladder and rectum,no statistically significant dose differences were found between BMS-IMRT and IMRT(P>0.05).Conclusion: For patients with cervical cancer after hysterectomy,the BMS-IMRT is superior to the IMRT and 3D-CRT in reducing dose to bone marrow volume.The IMRT with bone marrow sparing may reduce acute hematologic toxicities.更多还原